FHI Partners with the World Food Programme — Family Health International (FHI) in Kenya is partnering with the World Food Programme to provide a care package that includes food support to those receiving antiretroviral therapy (ART). In Kenya, FHI supports provision of care to over 180,000 people living with HIV (PLHIV), and over 35,000 of those with ART.

Through the USAID APHIA Coast and Rift Valley projects, FHI also supports establishment of comprehensive care centers (CCCs) at health facilities and builds the capacity of private sector organizations to provide HIV care.This experience has revealed that many PLHIV who go for treatment suffer from the combined burden of HIV, hunger, and poverty. Drugs alone are insufficient for this most vulnerable and food insecure population, because HIV and malnutrition interact in complex ways to exacerbate disease and nutritional problems. Malnutrition hastens progression of HIV infection to AIDS, and it increases mortality, risk of opportunistic infections (OIs), and immunologic decline. These problems combine to shorten survival rates. Thus, nutritional therapy should be an important aspect of improving health outcomes for PLHIV, and integration of nutrition interventions an important consideration in HIV/AIDS care and treatment activities. Most programs tend to focus only on the malnourished patients, and not the food insecurity that may exist at the household level. When nutritional supplementary food is provided to individual PLHIV, they tend to share with their families. As a result, the patients do not get all the nutritional benefits.

Other patients benefit from the nutritional support for the period they are in the program, but regress soon after they are weaned off. The intervention is for PLHIV who have a nutritional deficiency and their immediate family members who face food insecurity in two districts of Coast Province. Under this program, patients receiving care at CCCs are assessed for nutritional status. In addition, orphans and other vulnerable children (OVC) and members of child-headed households are enrolled irrespective of their HIV status. Field workers assess the food security of the patients' households. Those that are food insecure are included in the program, and food rations are provided for the entire household. The patients and food-insecure households receive corn-soya blend, pulses, cereals, and vegetable oil for an initial period of four months. Households that are food secure will only receive rations of corn-soya blend. These food rations represent 50 percent of the household monthly food requirements.

Reassessment of the nutritional status for the patients is done monthly, and the household food security is reassessed at month four. Food support is provided in cycles of four months to a maximum of 12 months, but the aim is to wean beneficiaries from food support after eight months. Because the food support is a short-term measure, interventions are simultaneously implemented to link household members to economic strengthening initiatives for long-term sustainable benefits such as training in agriculture and small-scale business enterprises linked to local internal saving and lending schemes and microfinance programs. Family Health International and WFP will disseminate the outcomes of this pilot program to inform other implementers of care and treatment programs of new approaches and effective models to integrate nutrition and food security into the care and treatment of

Pauline, 8, lives in a tiny shack in a slum in Nakuru, Kenya, with her orphaned cousins Maureen (not pictured) and Francis, who at 18 is head of household. They are visited by a field worker. Through FHI's pilot partnership with WFP, orphans and vulnerable children and members of child-led households receive food assistance regardless of HIV status.